LLM4CKD: Large Language Models for Early Stage Chronic Kidney Disease Screening

Early screening of chronic kidney disease (CKD) is critical for timely intervention, yet most machine learning (ML) and deep learning (DL) approaches require labeled data and model training, limiting their use in real-world screening settings. This study evaluates the effectiveness of large language models (LLMs) for CKD screening under zero-shot and few-shot in-context learning settings and compares them with traditional ML and DL methods. We propose a framework that uses clinically selected tabular features and structured prompt templates to enable LLM-based inference without task-specific training. LLM performance is evaluated across multiple prompt styles, feature configurations, and data settings, and compared with standard ML, DL, and tabular foundation model (TFM) baselines, and existing CKD screening tools. The results show that LLMs can achieve competitive performance using only a small number of examples, often matching or outperforming traditional approaches in low-data settings. However, their performance remains model-dependent and less stable as input complexity increases. In contrast, ML, DL, and TFM models show more consistent improvement with larger training data. Overall, the findings highlight a trade-off between data efficiency and stability, suggesting that LLMs may serve as a flexible complementary approach for CKD screening when labeled data are limited.

TSPFN: A Temporal Tabular Foundation Model for Physiological Time Series Classification

Designing models that generalize effectively in low- to medium-data regimes remains a primary challenge in medical machine learning, particularly for physiological time-series classification. While tabular foundation models such as TabPFN offer an attractive alternative to conventional fine-tuning through in-context learning, they are not designed to capture the temporal dependencies inherent to physiological signals. ~In this paper, we introduce TSPFN, a foundation model that redesigns TabPFN's architecture for time series data. TSPFN integrates structured temporal representations and positional embeddings to capture intra-sample temporal and channel dependencies. To fully leverage its spatio-temporal design, the model is pretrained on 140,000 real-world physiological time series across multiple medical domains. This yields a unified, generalizable framework capable of learning the specificities of medical time series. Experiments across diverse physiological benchmarks demonstrate that TSPFN consistently outperforms standard tabular baselines and TabPFN, and achieves superior cross-domain generalization compared to specialized deep time-series models. All our experiments, ablation studies, and pre-processing scheme are publicly available at https://github.com/Jeremstym/TSPFN

Coarse composition suffices: tabular in-context learning for multi-activity antimicrobial peptide profiling

Antimicrobial peptides (AMPs) often act against multiple pathogen classes, making multi-label activity prediction a more realistic screening target than binary antimicrobial classification. The ESCAPE benchmark formalizes this setting, but leading approaches typically rely on multimodal, structure-conditioned deep models that are costly to train and tune. We show that a simple, sequence-only pipeline can match and surpass these methods by combining 330 interpretable sequence descriptors with TabPFN, a tabular foundation model that performs in-context prediction in a single forward pass without gradient-based training or hyperparameter search. On ESCAPE (82,359 peptides; five labels), a label-powerset TabPFN model achieves mAP-5 = 77.8%, improving on the previously best reported 72.1%. A probabilistic classifier chain is the first method to match or exceed the best published average precision on each of the five labels simultaneously. The gains persist under the prior state-of-the-art single-fold training protocol, indicating they are not a training-set-size artefact, and are largest for remote homologues (+11.2 points below 30% sequence identity). Ablations further show that predicted structure is unnecessary at inference and that performance is not driven by any single descriptor family: ten global physicochemical scalars recover 91% of full-feature performance. Finally, explicitly modelling label dependence yields targeted benefits for scarce activities and supports ranking which activity to assay next from partial positive evidence.

Institution-Specific LLM Prompting Recovers PHI That De-identification Systems and Their Gold Standards Both Miss

Secondary use of electronic health records requires de-identification, yet existing systems miss \emph{institutionally situated} protected health information (PHI) such as hospital abbreviations, building names, and internal codes whose status is locally determined. We ask whether large language models (LLMs) with in-context learning (ICL) can close this gap and control the precision--recall trade-off. On 100 annotated pediatric oncology notes (5,322 PHI spans) from Texas Children's Hospital, we benchmarked eight LLMs against two purpose-built systems (Stanford TiDE, OpenMed PII) and two pattern-based baselines. Each LLM ran under three prompts of increasing specificity: (1) a HIPAA-aligned baseline, (2) baseline plus the institutional PHI categories it missed, and (3) prompt 2 plus instructions against over-redacting clinical content. We then compared 14~multi-agent and ensemble configurations against the best single prompt, with recall the primary safety metric. LLMs outperformed the purpose-built systems (best F1=0.918$\pm$0.001 vs.\ TiDE 0.779), with advantages concentrated in contextual categories. Naming the missed categories recovered 79\% (48/61) of them, and discouraging over-redaction restored precision. No agentic architecture beat calibrated single-pass prompting (F1 0.906--0.907), but LLM outputs surfaced 414~candidate annotation gaps; re-annotation confirmed 227~PHI spans, against which the final prompt reached recall=0.981 (F1=0.907$\pm$0.002). Well-calibrated ICL resolves both the institutional PHI gap and the precision--recall trade-off in one LLM call per note. LLMs cost more to run than traditional methods, but that cost buys a way to audit the reference standard. LLMs are a legitimate, adaptable alternative to purpose-built de-identification systems; institution-specific prompt development should be the primary adaptation strategy.

Policy Iteration with Human Feedback: Bringing Post-Training RL to In-context Learning

Generative pretraining established reusable task representations; later work on language-based task conditioning and in-context learning showed that a fixed model could adapt its behavior from instructions and demonstrations. Policy Iteration with Human Feedback (PIHF) builds on this development and the recurrent evaluate-and-improve structure of generalized policy iteration. PIHF uses a pretrained language model as its execution substrate and moves persistent revision to a versioned natural-language policy and tool set. A language-model critic and clinical expert review complete-panel reasoning and tool-use trajectories to localize recurrent failures and form candidate revisions; the expert may reinterpret the evidence and retains authority over admission and rollback, while Recall@1 and Recall@5 validate outcomes after candidate execution. Across cumulative ablations and ultra-rare-disease benchmarks, a PIHF-derived policy improved Recall@1 in one proprietary executor and three open-weight executors spanning 3 to 49 billion active parameters. Gains were 32.7 percentage points for GPT-5.4 and 31.1 points for Qwen3.6-35B, a difference of 1.7 points. These results support the feasibility of using pretrained language models as fixed-weight execution substrates for expert-guided policy development in rare-disease diagnosis.

ScreenShot: A Foundation Model for Few-Shot Combination Drug Screening

Treating patients with combinations of drugs reduces the risk of resistance to any individual drug. Finding effective combinations is difficult because the large search space makes combinatorial screens prohibitively expensive, time consuming, and often technically infeasible. Predictive models can fill this gap, yet existing methods typically require molecular profiling of each sample and per-cohort training, limiting their applicability when time and tissue are scarce. To address this challenge, we introduce ScreenShot, a hierarchical transformer pretrained on 40 drug screening datasets covering 3,700 drugs and 6,000 biological samples, whose architecture mirrors the nested structure of screening data. Given a few-shot context of observations from a new patient, ScreenShot predicts the response of the sample to combination therapies through in-context learning, operating directly on functional measurements with no fine-tuning and no molecular profiling. On four held-out datasets, ScreenShot outperforms all baselines in both prediction accuracy and identification of selectively effective treatments. ScreenShot's internal representations are directly useful for experimental design: we use them to drive a weighted k-means++ active learning strategy that selects which experiments to run, achieving the same hit detection as uniform screening with a third of the budget. Source code and interactive dashboard: https://github.com/tansey-lab/screenshot.

PerturbPFN: Probing the Limits of Synthetic Priors in Drug Perturbation Modelling

Predicting cellular responses to unseen chemical perturbations is challenging due to unknown targets and mechanisms, high-dimensional expression responses, and limited experimental coverage of the large small-molecule design space. We propose PerturbPFN, a PFN-style amortized model for unknown-target perturbation prediction under a hierarchical synthetic structural prior. Instead of directly regressing high-dimensional expression responses, PerturbPFN infers a latent system graph, sparse atomic intervention targets, and intervention strengths, then propagates their effects through an SCM decoder. The model is trained entirely on prior-predictive synthetic episodes generated from biologically motivated graph and expression simulators, enabling structured in-context learning without test-time gradient updates. We evaluate PerturbPFN on both real single-cell perturbation data and synthetic benchmarks, covering effect prediction, target identification, and regulatory structure discovery. Our results show that PerturbPFN offers a complementary trade-off to specialized baselines, achieving competitive perturbation prediction with low inference cost while exposing interpretable intermediate estimates of targets, strengths, and system structure.

In-Context Learning for Wound Classification with Small Multimodal Language Models

Wound image classification is often treated as a task-specific supervised learning problem, requiring substantial amounts of manually labelled data and retraining when the label space or deployment setting changes. This study evaluated whether small multimodal language models (SMLMs) can provide a training-free alternative for wound classification through retrieval-based in-context learning (ICL). Experiments used two public wound-image datasets: the Kaggle wound dataset (1469 images, 10 classes) and the Medetec dataset (560 images, 9 classes). Eleven SMLMs from the Qwen 3.5, Ministral 3, and Gemma 4 families were evaluated under zero-shot prompting and few-shot prompting with random support examples, embedding-based k-nearest-neighbour (kNN) retrieval, and kNN retrieval followed by maximal marginal relevance reranking (MMR). Retrieval-only weighted-kNN controls, support-set reduction experiments, and support-context size sweeps were used to assess the effects of retrieval, model scale, and prompt length. Query-conditioned ICL consistently outperformed zero-shot and random few-shot prompting. On the Kaggle dataset, the best result was achieved by Qwen 3.5 27B with kNN+MMR, reaching 0.872 accuracy and 0.871 F1 score. On Medetec, Qwen 3.5 27B with kNN+MMR reached 0.678 accuracy and 0.670 F1. Larger models exceeded matched weighted-kNN controls, indicating use of retrieved examples beyond nearest-neighbour voting. Retrieval-based ICL degraded modestly under support-set reduction, and most gains saturated with 8-10 support images. Retrieval-based ICL allows SMLMs to perform adaptable wound image classification without task-specific retraining. Compact retrieved contexts may support practical and privacy-conscious deployment, although performance remains dependent on model scale, retrieval strategy, and dataset difficulty.

UniMedSeg: Unified In-Context Learning for Multi-Paradigm 2D/3D Medical Image Segmentation

Medical image segmentation foundation models are expected to generalize across diverse clinical scenarios, yet existing universal methods remain fragmented by prompt paradigms and spatial dimensions. Visual in-context learning, interactive segmentation, and language-guided segmentation are typically handled by paradigm-specific models, while 2D and 3D images are also modeled separately. Such isolation prevents heterogeneous annotations and data from being jointly absorbed by a single scalable model and limits cross-paradigm knowledge transfer. To address this bottleneck, we propose UniMedSeg, a Transformer-centric universal segmentation framework that maps visual examples, geometric interactions, language instructions, and 2D/3D images into a shared sequence space, enabling heterogeneous medical supervision to be jointly learned through a unified in-context interface without prompt- or dimension-specific branches. To overcome the long-sequence memory bottleneck caused by visual contexts, we introduce Decoupled Split Attention, which reduces attention complexity to linear while preserving hardware-friendly computation and focused context-target interaction. Extensively trained and evaluated on a large corpus curated from 27 public datasets, UniMedSeg achieves state-of-the-art performance across visual in-context, interactive, and language-guided segmentation without task-specific fine-tuning, demonstrating strong generalization on diverse held-out tasks. The code and model weights are publicly available at https://github.com/Lii1228/UniMedSeg

AbICL: In-Context Learning for Antigen-Specific Antibody Affinity Ranking

Accurate ranking of antibody candidates according to their binding affinity is essential for therapeutic antibody discovery. However, existing methods treat affinity comparisons independently and ignore the contextual information encoded in other labeled comparisons, limiting their ability to capture antigen-specific binding landscapes. For many target antigens, a small number of experimentally characterized affinity comparisons are often available. An important question is whether the model can exploit these existing comparisons to infer antigen-specific ranking patterns that facilitate subsequent affinity ranking. This form of learning from labeled demonstrations closely resembles the paradigm of In-Context Learning, motivating us to revisit antibody affinity ranking from an ICL perspective. To this end, we propose AbICL, an ICL framework for antigen-specific antibody affinity ranking. AbICL combines a pretrained structural encoder with a context ranking head and is trained with an episodic meta-training strategy that enables the model to leverage support demonstrations for test-time adaptation without gradient updates. Experiments on the AbRank benchmark demonstrate that AbICL consistently outperforms existing ranking baselines across almost all data splits and evaluation benchmarks. Further analysis shows that the value of contextual demonstrations depends on how well they match the target inference task, and becomes increasingly pronounced under distribution shift and fine-grained affinity discrimination. These findings highlight the potential of ICL as an effective paradigm for antigen-specific antibody affinity ranking, particularly in challenging settings where a single global ranking function is insufficient.

Can Tabular In-Context Learners Generalize to Biomolecular Property Prediction?

Predicting biomolecular properties from limited labeled data is a central bottleneck in protein engineering and small-molecule design. As strong pretrained encoders now supply rich fixed-length representations, the difficulty has shifted from representation learning to building a data-efficient predictor for the few-shot regime. Tabular foundation models such as TabPFN3 and TabICL are unlikely candidates for this role: they are in-context learners pretrained on synthetic tables drawn from random causal graphs, a generative prior with no obvious correspondence to the processes that produce protein sequences or molecular graphs. That this tabular, causal inductive bias should transfer to biomolecular data at all is unintuitive, yet we find it does. Treating each method as a predictor-representation pair, we evaluate across two domains. Over a fixed ESMC representation, tabular in-context learning is consistently competitive for protein fitness regression on ProteinGym and a diverse esterase dataset. For small-molecule classification with ECFP/RDKit descriptors, no single pairing dominates across TDC ADMET, MoleculeNet, FS-Mol, and DrugOOD; representation choice becomes a primary determinant, as expected when the predictor's own prior is indifferent to molecular structure. We conclude that tabular foundation models are strong performers on biomolecular prediction tasks, but that their performance depends strongly on the sequence or molecular representation used.

Unlocking In-Context Learning in Audio-Language Models from Decentralized Medical Audio

Clinical audio diagnosis in low-resource settings requires models that identify conditions from minimal examples without large annotated corpora. We propose Federated Self-Contextualization (FSC), a multimodal language model framework for in-context clinical audio diagnosis across federated hospital clients. FSC constructs pseudo-label episodes via unsupervised clustering of audio representations, bypassing scarce real diagnostic labels, and enables contextual reasoning from support-query pairs. Our progressive three-stage pipeline first aligns audio embeddings with the language model via caption-based pretraining, then adapts it for episodic in-context inference through federated optimization. At test time, given a small labeled support set, the model diagnoses an unseen query through multimodal reasoning. On held-out respiratory and cardiac conditions, FSC achieves 71.6% accuracy in 2-way 2-shot evaluation, outperforming audio-language baselines by over 9%.